ACR Appropriateness Criteria® Acute Respiratory Illness in Immunocompromised Patients

J Am Coll Radiol. 2019 Nov;16(11S):S331-S339. doi: 10.1016/j.jacr.2019.05.019.


The immunocompromised patient with an acute respiratory illness (ARI) may present with fever, chills, weight loss, cough, shortness of breath, or chest pain. The number of immunocompromised patients continues to rise with medical advances including solid organ and stem cell transplantation, chemotherapy, and immunomodulatory therapy, along with the continued presence of human immunodeficiency virus and acquired immunodeficiency syndrome. Given the myriad of pathogens that can infect immunocompromised individuals, identifying the specific organism or organisms causing the lung disease can be elusive. Moreover, immunocompromised patients often receive prophylactic or empiric antimicrobial therapy, further complicating diagnostic evaluation. Noninfectious causes for ARI should also be considered, including pulmonary edema, drug-induced lung disease, atelectasis, malignancy, radiation-induced lung disease, pulmonary hemorrhage, diffuse alveolar damage, organizing pneumonia, lung transplant rejection, and pulmonary thromboembolic disease. As many immunocompromised patients with ARI progress along a rapid and potentially fatal course, timely selection of appropriate imaging is of great importance in this setting. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking, or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.

Keywords: AUC; Acute respiratory illness; Appropriate Use Criteria; Appropriateness Criteria; Immunocompromised patient; Medical imaging.

Publication types

  • Review

MeSH terms

  • Acute Disease
  • Contrast Media
  • Evidence-Based Medicine
  • Female
  • Humans
  • Image-Guided Biopsy / methods
  • Immunocompromised Host / immunology*
  • Magnetic Resonance Imaging / methods
  • Male
  • Positron Emission Tomography Computed Tomography / methods*
  • Practice Guidelines as Topic
  • Radiography, Thoracic / methods
  • Radiology / standards
  • Respiratory Tract Infections / diagnostic imaging*
  • Respiratory Tract Infections / immunology
  • Respiratory Tract Infections / pathology*
  • Sensitivity and Specificity
  • Severity of Illness Index
  • Societies, Medical / standards
  • Tomography, X-Ray Computed / methods*
  • United States


  • Contrast Media